|
CYSTOURETHROSCOPY, WITH FULGURATION (INCLUDING CRYOSURGERY OR LASER SURGERY) AND/OR RESECTION OF; SMALL BLADDER TUMOR(S) (0.5 UP TO 2.0 CM)
|
Facility
|
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 52234
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,533.71 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,800.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,987.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,533.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,800.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,987.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,533.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,533.71
|
| Rate for Payer: Heritage Provider Network Senior |
$5,576.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,533.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$8,614.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,213.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,075.17
|
| Rate for Payer: Multiplan WC |
$6,982.34
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,987.08
|
| Rate for Payer: TriValley Medical Group Senior |
$4,987.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,454.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,273.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,800.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,987.08
|
| Rate for Payer: Vantage Medical Group Senior |
$4,533.71
|
|
|
CYSTOURETHROSCOPY, WITH INSERTION OF INDWELLING URETERAL STENT (EG, GIBBONS OR DOUBLE-J TYPE)
|
Facility
|
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 52332
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,533.71 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,800.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,987.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,533.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,800.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,987.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,533.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,533.71
|
| Rate for Payer: Heritage Provider Network Senior |
$5,576.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,533.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$8,614.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,213.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,075.17
|
| Rate for Payer: Multiplan WC |
$6,982.34
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,987.08
|
| Rate for Payer: TriValley Medical Group Senior |
$4,987.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,454.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,273.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,800.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,987.08
|
| Rate for Payer: Vantage Medical Group Senior |
$4,533.71
|
|
|
CYSTOURETHROSCOPY; WITH RESECTION OR FULGURATION OF ORTHOTOPIC URETEROCELE(S), UNILATERAL OR BILATERAL
|
Facility
|
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 52300
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,533.71 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,800.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,987.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,533.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,800.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,987.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,533.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,533.71
|
| Rate for Payer: Heritage Provider Network Senior |
$5,576.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,533.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$8,614.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,213.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,075.17
|
| Rate for Payer: Multiplan WC |
$6,982.34
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,987.08
|
| Rate for Payer: TriValley Medical Group Senior |
$4,987.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,454.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,273.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,800.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,987.08
|
| Rate for Payer: Vantage Medical Group Senior |
$4,533.71
|
|
|
CYSTOURETHROSCOPY, WITH URETERAL CATHETERIZATION, WITH OR WITHOUT IRRIGATION, INSTILLATION, OR URETEROPYELOGRAPHY, EXCLUSIVE OF RADIOLOGIC SERVICE;
|
Facility
|
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 52005
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,688.58 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,032.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,957.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,688.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,032.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,957.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,688.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,688.58
|
| Rate for Payer: Heritage Provider Network Senior |
$3,306.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,688.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$5,108.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,091.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,602.70
|
| Rate for Payer: Multiplan WC |
$4,147.14
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,957.44
|
| Rate for Payer: TriValley Medical Group Senior |
$2,957.44
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,454.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,273.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,032.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,957.44
|
| Rate for Payer: Vantage Medical Group Senior |
$2,688.58
|
|
|
CYSTOURETHROSCOPY, WITH URETEROSCOPY AND/OR PYELOSCOPY; DIAGNOSTIC
|
Facility
|
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 52351
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,533.71 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,800.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,987.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,533.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,245.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,800.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,987.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,533.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,533.71
|
| Rate for Payer: Heritage Provider Network Senior |
$5,576.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,533.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$8,614.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,213.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,075.17
|
| Rate for Payer: Multiplan WC |
$6,982.34
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,987.08
|
| Rate for Payer: TriValley Medical Group Senior |
$4,987.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,454.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,273.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,800.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,987.08
|
| Rate for Payer: Vantage Medical Group Senior |
$4,533.71
|
|
|
CYSTOURETHROSCOPY, WITH URETEROSCOPY AND/OR PYELOSCOPY; WITH LITHOTRIPSY INCLUDING INSERTION OF INDWELLING URETERAL STENT (EG, GIBBONS OR DOUBLE-J TYPE)
|
Facility
|
OP
|
$13,102.72
|
|
|
Service Code
|
CPT 52356
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,158.00 |
| Max. Negotiated Rate |
$13,102.72 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,344.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,585.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,896.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,344.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,585.79
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,896.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$6,896.17
|
| Rate for Payer: Heritage Provider Network Senior |
$8,482.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,896.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$13,102.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,930.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9,240.87
|
| Rate for Payer: Multiplan WC |
$10,291.67
|
| Rate for Payer: TriValley Medical Group Commercial |
$7,585.79
|
| Rate for Payer: TriValley Medical Group Senior |
$7,585.79
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12,150.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10,259.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,344.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,585.79
|
| Rate for Payer: Vantage Medical Group Senior |
$6,896.17
|
|
|
CYSTOURETHROSCOPY, WITH URETEROSCOPY AND/OR PYELOSCOPY; WITH REMOVAL OR MANIPULATION OF CALCULUS (URETERAL CATHETERIZATION IS INCLUDED)
|
Facility
|
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 52352
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,533.71 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,800.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,987.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,533.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,800.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,987.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,533.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,533.71
|
| Rate for Payer: Heritage Provider Network Senior |
$5,576.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,533.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$8,614.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,213.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,075.17
|
| Rate for Payer: Multiplan WC |
$6,982.34
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,987.08
|
| Rate for Payer: TriValley Medical Group Senior |
$4,987.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,454.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,273.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,800.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,987.08
|
| Rate for Payer: Vantage Medical Group Senior |
$4,533.71
|
|
|
CYTARABINE (PF) 2 GRAM/20 ML (100 MG/ML) INJECTION SOLUTION [20156]
|
Facility
|
IP
|
$1.25
|
|
|
Service Code
|
HCPCS J9100
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$0.94 |
| Rate for Payer: Cigna of CA HMO/PPO |
$0.58
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.51
|
| Rate for Payer: Adventist Health Commercial |
$0.25
|
| Rate for Payer: Adventist Health Commercial |
$0.22
|
| Rate for Payer: Adventist Health Commercial |
$0.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.79
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.71
|
| Rate for Payer: Cash Price |
$0.56
|
| Rate for Payer: Cash Price |
$0.55
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.51
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.56
|
| Rate for Payer: Heritage Provider Network Senior |
$0.56
|
| Rate for Payer: Heritage Provider Network Senior |
$0.51
|
| Rate for Payer: Heritage Provider Network Senior |
$0.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.31
|
| Rate for Payer: Multiplan Commercial |
$0.94
|
| Rate for Payer: Multiplan Commercial |
$0.83
|
| Rate for Payer: Multiplan Commercial |
$0.92
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.45
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.44
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.41
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.36
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.40
|
|
|
CYTARABINE (PF) 2 GRAM/20 ML (100 MG/ML) INJECTION SOLUTION [20156]
|
Facility
|
OP
|
$1.10
|
|
|
Service Code
|
HCPCS J9100
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$15.71 |
| Rate for Payer: Adventist Health Commercial |
$0.22
|
| Rate for Payer: Adventist Health Commercial |
$0.24
|
| Rate for Payer: Adventist Health Commercial |
$0.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.77
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.71
|
| Rate for Payer: Blue Shield of California Commercial |
$0.99
|
| Rate for Payer: Blue Shield of California Commercial |
$0.99
|
| Rate for Payer: Blue Shield of California Commercial |
$0.99
|
| Rate for Payer: Blue Shield of California EPN |
$0.99
|
| Rate for Payer: Blue Shield of California EPN |
$0.99
|
| Rate for Payer: Blue Shield of California EPN |
$0.99
|
| Rate for Payer: Cash Price |
$0.55
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cash Price |
$0.56
|
| Rate for Payer: Cash Price |
$0.56
|
| Rate for Payer: Cash Price |
$0.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.51
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.56
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.51
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.58
|
| Rate for Payer: Heritage Provider Network Senior |
$0.56
|
| Rate for Payer: Heritage Provider Network Senior |
$0.51
|
| Rate for Payer: Heritage Provider Network Senior |
$0.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.85
|
| Rate for Payer: Multiplan Commercial |
$0.92
|
| Rate for Payer: Multiplan Commercial |
$0.94
|
| Rate for Payer: Multiplan Commercial |
$0.83
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.49
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.44
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.50
|
| Rate for Payer: TriValley Medical Group Senior |
$0.50
|
| Rate for Payer: TriValley Medical Group Senior |
$0.49
|
| Rate for Payer: TriValley Medical Group Senior |
$0.44
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.45
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.44
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.36
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.04
|
| Rate for Payer: Vantage Medical Group Senior |
$0.94
|
| Rate for Payer: Vantage Medical Group Senior |
$1.06
|
| Rate for Payer: Vantage Medical Group Senior |
$1.04
|
|
|
CYTOMEGALOVIRUS IMMUNE GLOBULIN 50 MG/ML INTRAVENOUS SOLUTION [14634]
|
Facility
|
OP
|
$44.73
|
|
|
Service Code
|
HCPCS J0850
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.10 |
| Max. Negotiated Rate |
$2,490.82 |
| Rate for Payer: Adventist Health Commercial |
$8.95
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$27.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,323.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,044.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,044.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,635.33
|
| Rate for Payer: Blue Shield of California Commercial |
$1,791.99
|
| Rate for Payer: Blue Shield of California EPN |
$1,791.99
|
| Rate for Payer: Cash Price |
$20.13
|
| Rate for Payer: Cash Price |
$20.13
|
| Rate for Payer: Cigna of CA HMO/PPO |
$20.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,323.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,044.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,044.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.63
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,858.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$20.71
|
| Rate for Payer: Heritage Provider Network Senior |
$20.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,858.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$21.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,137.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,490.82
|
| Rate for Payer: Multiplan Commercial |
$33.55
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.89
|
| Rate for Payer: TriValley Medical Group Senior |
$17.89
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$16.16
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,323.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,044.70
|
| Rate for Payer: Vantage Medical Group Senior |
$2,044.70
|
|
|
CYTOMEGALOVIRUS IMMUNE GLOBULIN 50 MG/ML INTRAVENOUS SOLUTION [14634]
|
Facility
|
IP
|
$44.73
|
|
|
Service Code
|
HCPCS J0850
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.10 |
| Max. Negotiated Rate |
$33.55 |
| Rate for Payer: Adventist Health Commercial |
$8.95
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$28.81
|
| Rate for Payer: Cash Price |
$20.13
|
| Rate for Payer: Cigna of CA HMO/PPO |
$20.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$20.71
|
| Rate for Payer: Heritage Provider Network Senior |
$20.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.18
|
| Rate for Payer: Multiplan Commercial |
$33.55
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$16.16
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.81
|
|
|
D010B6Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD D010B6Z
|
| Hospital Charge Code |
5446
|
| Min. Negotiated Rate |
$9,120.00 |
| Max. Negotiated Rate |
$9,120.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,120.00
|
|
|
D010BB1
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD D010BB1
|
| Hospital Charge Code |
5447
|
| Min. Negotiated Rate |
$9,120.00 |
| Max. Negotiated Rate |
$9,120.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,120.00
|
|
|
D011B6Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD D011B6Z
|
| Hospital Charge Code |
5448
|
| Min. Negotiated Rate |
$9,120.00 |
| Max. Negotiated Rate |
$9,120.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,120.00
|
|
|
D011BB1
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD D011BB1
|
| Hospital Charge Code |
5449
|
| Min. Negotiated Rate |
$9,120.00 |
| Max. Negotiated Rate |
$9,120.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,120.00
|
|
|
D016B6Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD D016B6Z
|
| Hospital Charge Code |
5450
|
| Min. Negotiated Rate |
$9,120.00 |
| Max. Negotiated Rate |
$9,120.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,120.00
|
|
|
D016BB1
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD D016BB1
|
| Hospital Charge Code |
5451
|
| Min. Negotiated Rate |
$9,120.00 |
| Max. Negotiated Rate |
$9,120.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,120.00
|
|
|
D017B6Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD D017B6Z
|
| Hospital Charge Code |
5452
|
| Min. Negotiated Rate |
$9,120.00 |
| Max. Negotiated Rate |
$9,120.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,120.00
|
|
|
D017BB1
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD D017BB1
|
| Hospital Charge Code |
5453
|
| Min. Negotiated Rate |
$9,120.00 |
| Max. Negotiated Rate |
$9,120.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,120.00
|
|
|
D710B6Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD D710B6Z
|
| Hospital Charge Code |
5454
|
| Min. Negotiated Rate |
$9,120.00 |
| Max. Negotiated Rate |
$9,120.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,120.00
|
|
|
D710BB1
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD D710BB1
|
| Hospital Charge Code |
5455
|
| Min. Negotiated Rate |
$9,120.00 |
| Max. Negotiated Rate |
$9,120.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,120.00
|
|
|
D711B6Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD D711B6Z
|
| Hospital Charge Code |
5456
|
| Min. Negotiated Rate |
$9,120.00 |
| Max. Negotiated Rate |
$9,120.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,120.00
|
|
|
D711BB1
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD D711BB1
|
| Hospital Charge Code |
5457
|
| Min. Negotiated Rate |
$9,120.00 |
| Max. Negotiated Rate |
$9,120.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,120.00
|
|
|
D712B6Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD D712B6Z
|
| Hospital Charge Code |
5458
|
| Min. Negotiated Rate |
$9,120.00 |
| Max. Negotiated Rate |
$9,120.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,120.00
|
|
|
D712BB1
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD D712BB1
|
| Hospital Charge Code |
5459
|
| Min. Negotiated Rate |
$9,120.00 |
| Max. Negotiated Rate |
$9,120.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,120.00
|
|
